The causes of death and postmortem characteristics of Pima Indians of the Gila River Indian Community are investigated so that findings in subjects with and without diabetes mellitus can be correlated with studies in living subjects. Medical records are reviewed for the determination of cause of death and for the occurrence of certain serious diseases or complications of diabetes. The purpose of the study is to relate the outcome and cause of death to events or risk factors measured in life among Pima Indian residents of the Gila River Indian Community, particularly in relation to diabetes, cardiovascular diseases and gallbladder disease. Death Certificates are obtained on all members of the Gila River Indian Community In addition, post mortem examinations and all available medical records pertaining to the subjects are obtained to ascertain conditions present at the time of death and ascertain cause of death as precisely as possible. These records are reviewed in a standardized way for evidence of the complications of diabetes, vascular disease, neoplasms and other conditions. The records are used to determine the causes of death and incidence of complications associated with diabetes and other conditions identified initially during life by the longitudinal epidemiologic studies in the population. Detailed review of causes of death from 1965-1990 have been completed. Analyses have shown that among those with diabetes the proportion of deaths from renal disease as the underlying cause have diminished, while the proportion due to cardiovascular diseases has increased during this period.